PubMed Health⌕ Search

Biomedical subjects

A R Gaudio

Publications and source records attributed to A R Gaudio.

15 recordsLinked to original sources
PubMed2001

Latanoprost and cystoid macular edema in high-risk aphakic or pseudophakic eyes.

PURPOSE: To determine the magnitude of the association between latanoprost use and cystoid macular edema (CME) in high-risk aphakic or pseudophakic eyes. SETTING: Single referral glaucoma practice. METHODS: In a referral glaucoma practice, 40 consecutive patients with glaucoma uncontrolled on maximally tolerated medications without latanoprost were studied. Seven eyes were aphakic, and 33 eyes were pseudophakic. All eyes had an absent or open posterior capsule, and 29 eyes had 1 or more additional risk factors for developing CME. Latanoprost 0.005%, 1 drop at bedtime, was added to the patients' current regimen. Patients were instructed to check their vision in the treated eye daily at home and to report any perceived decrease promptly. Patients without a change in vision or other side effects were reexamined 1 month after initiating latanoprost and every 3 months thereafter. If there was a greater than 1 line decrease in visual acuity, a retinal evaluation and fundus fluorescein angiography (FFA) were performed by a retina specialist. RESULTS: Two eyes had to discontinue latanoprost because of side effects before the 1 month visit. They were excluded from the analysis. At the 1 month follow-up, the mean intraocular pressure was 18.2 mm Hg +/- 6.5 (SD), a decrease from the pretreatment mean of 21.5 +/- 5.7 mm Hg. The visual acuity was within 1 line of baseline in 36 eyes and decreased by 2 lines in 2 eyes. In these 2 eyes, symptomatic CME was documented by FFA. The CME clinically resolved, with visual acuity returning to baseline after the latanoprost was discontinued and a nonsteroidal antiinflammatory drug started. There were no additional cases of CME after a mean follow-up of 5.7 months. CONCLUSION: Approximately 5% of high-risk eyes treated with latanoprost developed clinically symptomatic and angiographically documented CME. The temporal relationship between initiation of treatment and the decreased vision in our 2 cases suggests but does not establish a causal relationship between CME and latanoprost. With appropriate informed consent and attentive follow-up, clinicians should not be deterred from using this important glaucoma medication.

Aged↗
PubMed2000

Visually significant cystoid macular edema in pseudophakic and aphakic patients with glaucoma receiving latanoprost.

PURPOSE: To investigate the incidence of visually significant cystoid macular edema associated with the use of latanoprost in patients with glaucoma after cataract surgery. PATIENTS AND METHODS: This is a multicenter, retrospective study of 185 patients, of whom 173 were pseudophakic (212 eyes) and 12 were aphakic (13 eyes), who were treated for glaucoma with latanoprost 0.005%. The posterior lens capsule was intact in 125 eyes, open or absent as a result of surgery in 25 eyes, and status-post-yttrium-aluminum-garnet capsulotomy in 75 eyes. Visual acuity was documented before and after initiating latanoprost therapy, and patients with a reduction of two or more lines on the Snellen chart were examined by fluorescein angiography for cystoid macular edema. RESULTS: Visual reduction was documented in four (2.16%) patients. Three of the four patients had cystoid macular edema, and the fourth was thought to have lost a central island of vision from glaucoma. The three patients with cystoid macular edema all had ruptured posterior capsules, requiring anterior vitrectomy, and one had a previous episode of cystoid macular edema 3 years before starting latanoprost therapy. CONCLUSION: These findings suggest that visually significant cystoid macular edema associated with latanoprost therapy in pseudophakic or aphakic patients is uncommon. If there is a cause-and-effect relationship between latanoprost therapy and clinically significant cystoid macular edema, the incidence appears to be low.

Adolescent↗
PubMed1998

High-risk characteristics of fellow eyes of patients with unilateral neovascular age-related macular degeneration.

OBJECTIVE: This study aimed to determine whether clinical tests of ocular function and macular appearance independently can help to predict which patients with unilateral neovascular age-related macular degeneration (AMD) will have a choroidal neovascular membrane (CNVM) develop in their fellow eye. DESIGN: The study design was a prospective cohort study. PARTICIPANTS: One hundred twenty-seven patients with unilateral neovascular AMD observed for up to 4.5 years participated. INTERVENTION: Functional measurements included visual acuity, macular visual field, glare recovery time, and foveal electroretinogram amplitude and implicit time. MAIN OUTCOME MEASURE: The age-adjusted proportion of patients having a CNVM develop over follow-up assessed by the Cox proportional hazards model with stepwise selection was measured. RESULTS: On average, 8.8% of patients had a CNVM develop each year. Independent risk factors for the fellow eye were its glare recovery time in minutes (relative risk = 1.30, confidence interval = 1.10-1.54, P = 0.003) and its extent of visible macular abnormalities on a four-point scale (relative risk = 1.62, confidence interval = 1.06-2.59, P = 0.03). Of the fellow eyes that converted, the interval to have a CNVM develop was inversely related to the foveal electroretinogram implicit time. CONCLUSIONS: A slower recovery from glare and more extensive funduscopic changes appear to be independent risk factors for the development of a CNVM in the fellow eyes of patients with unilateral neovascular AMD. A slower foveal electroretinogram implicit time may be a sign of early stage CNVM development, perhaps because of outer retinal ischemia. These results have clinical management implications, particularly for those patients at high risk of having a potentially treatable form of AMD develop.

Aged↗
PubMed1998

The effect of a lower blood pressure on choroidal filling in age-related macular degeneration.

PURPOSE: To determine whether the occurrence of delayed choroidal filling or a slower foveal electroretinogram (ERG) implicit time is related to systemic blood pressure in patients with age-related macular degeneration. METHODS: We assessed delayed choroidal filling by fluorescein angiography and foveal ERG implicit time with a hand-held stimulator-ophthalmoscope for the fellow eye of 67 patients with unilateral neovascular age-related macular degeneration. Blood pressure, measured by ascultation, was converted to mean arterial pressure. The relations of delayed choroidal filling and foveal ERG implicit time to the mean arterial pressure were assessed by logistic and linear regression, respectively, controlling for age, gender, and intake of hypertensive medication. RESULTS: The probability of having delayed choroidal filling decreased with increasing mean arterial pressure (P = 0.01). The foveal ERG implicit time was also inversely related to the mean arterial pressure (P = 0.009). CONCLUSION: Delayed choroidal filling and foveal ERG implicit time are related to blood pressure in patients with age-related macular degeneration.

Aged↗
PubMed1995

Slow photostress recovery and disease severity in age-related macular degeneration.

PURPOSE: To determine whether photostress recovery time varies with severity of disease in age-related macular degeneration. METHODS: Photostress recovery time, visual acuity, and foveal retinal pigment epithelial atrophy were evaluated for the fellow eyes of 133 patients with unilateral neovascular age-related macular degeneration. Recovery times were measured by a method that flashed letters on a computer screen in random order before and after a 10 second bleach. RESULTS: Recovery times were delayed in 62% of the patients (including 47% of those with normal visual acuity), ranged up to 6 times the normal limit, and increased with advancing age (P < 0.0001). Photostress recovery time was inversely correlated with visual acuity (P < 0.0001) and longer in eyes with visible atrophy than in eyes without atrophy (P = 0.0007). Significant relationships between these two pairs of measures were also found after controlling for age. CONCLUSION: These findings support previous evidence that the time for visual recovery after exposure to a glare source is commonly slowed in age-related macular degeneration even among patients with normal visual acuity and further show that it can vary with age and extent of disease.

Adult↗
PubMed1995

Foveal electroretinograms and choroidal perfusion characteristics in fellow eyes of patients with unilateral neovascular age-related macular degeneration.

AIMS/BACKGROUND: A prolonged choroidal filling phase on fluorescein angiography has been reported to be a common finding and associated with visual function abnormalities in patients with age-related macular degeneration (AMD). This investigation was carried out to determine whether this perfusion defect was related to the slowing of foveal cone electroretinogram (ERG) implicit time seen in patients with AMD. METHODS: Fluorescein angiograms and foveal cone ERGs were evaluated in the fellow eyes of 67 patients with unilateral neovascular AMD. RESULTS: Twenty eight (42%) of the eyes had a choroidal perfusion defect. ERG implicit times averaged 1 ms slower (p = 0.0167) and were more likely to be delayed (p = 0.0078) in eyes with abnormal choroidal perfusion than in eyes with normal choroidal filling; significant relations were found also after controlling for age. ERG implicit time was also inversely related to ETDRS visual acuity and positively related to the extent of macular drusen; and the latter showed a borderline significant tendency to be more prevalent in eyes with prolonged choroidal perfusion. However, an association of a delayed ERG implicit time with prolonged choroidal filling remained after controlling for age, acuity, and the extent of drusen. CONCLUSION: These findings further establish prolonged choroidal perfusion as a common finding in AMD and link it to retinal malfunction.

Aged↗
PubMed1994

Visual field deficits in early age-related macular degeneration.

Patients with early age-related macular degeneration (AMD) may retain good visual acuity but experience distortion and other qualitative visual changes. The purpose of the present study was to determine whether deficits of form recognition, as well as of light sensitivity, were related to retinal pigment epithelial (RPE) atrophy and/or drusen. We assessed form recognition deficits by the Amsler grid and by a perimetric test of letter recognition and sensitivity deficits by the macular threshold test of the Humphrey Field Analyzer in 59 patients with AMD and visual acuities of 20/40 or better. The number of defects on each test was compared with the area of RPE atrophy and with the area of drusen determined from fundus photographs. Multiple regression analyses based on ordinal data revealed that the number of visual field defects by each test was significantly correlated with the area of atrophy, but not with the area of drusen. There was also no significant tendency for a patient with a regional preponderance of drusen to have more impairment in the corresponding visual field. These results suggest that deficits of form recognition, as well as of sensitivity, in patients with early stages of AMD can be attributed to alteration of photoreceptor function associated with RPE atrophy, but not with drusen.

Aging↗
PubMed1994

Iris pigmentation and extent of disease in patients with neovascular age-related macular degeneration.

PURPOSE: To determine whether the extent of disease in age-related macular degeneration (AMD) varies with iris pigmentation. METHODS: The authors assessed visual function and macular appearance in the fellow eye or both eyes of 132 white patients with unilateral neovascular AMD. All patients had a visual acuity of 20/60 or better in the fellow eye. Eighty-nine of the patients were coded as having light irides (blue, green, or hazel) and 43 were coded as having dark irides (brown); the two groups of patients had comparable mean ages. RESULTS: By the Mann-Whitney test for differences in mean rank, fellow eyes with light irides showed a marginally worse visual acuity (P = .156) but significantly more visual field impairment by letter recognition perimetry (P = .011) and the macular threshold test of the Humphrey Field Analyzer (P = .043), and more retinal pigment epithelial atrophy (P = .017) and focal areas of hyperpigmentation (P = .002) than fellow eyes with dark irides. For eyes with a choroidal neovascular membrane (CNVM), those with light irides had significantly lower visual acuities (P = .006) and larger scars (P = .006) than eyes with dark irides. In addition, extent of disease in the eye with a CNVM was positively correlated with extent of disease in the fellow eye for most comparisons. CONCLUSIONS: These observations suggest that light iris pigmentation is associated with more extensive retinal disease in patients with unilateral neovascular AMD. Furthermore, in such patients, those with worse disease in the eye with a CNVM may tend to have more extensive atrophic disease in the fellow eye.

Aged↗
PubMed1993

Hyperopia and neovascularization in age-related macular degeneration.

PURPOSE: Refractive errors for phakic eyes of patients referred with age-related macular degeneration were reviewed to determine whether some range of refractive error might be a risk factor for the neovascular form. METHODS: The authors compared refractive errors of 198 patients with unilateral neovascular disease with refractive errors of 129 patients with bilateral dry disease. These groups had comparable distributions with respect to age, sex, and visual acuity of their better eyes. Student's t tests and multiple linear regression analyses were performed to assess group differences in mean refractive error. Contingency table and multiple logistic regression analyses were performed to determine odds ratios for having the neovascular form based on a stratification of refractive error. RESULTS: By comparing better eyes of the two groups, patients with the unilateral neovascular form had an average spherical equivalent that was 1.0 diopter (D) more hyperopic than that of patients with the bilateral dry form (P < 0.001). Patients with a refractive error of +0.75 D or greater were more likely to have the neovascular form compared with patients with other refractive errors (odds ratio, 2.40; 95% confidence interval, 1.53-3.78; P < 0.001). Similar relationships between the two groups of patients were found by comparing worse eyes. CONCLUSION: These findings suggest that hyperopia is a risk factor for choroidal neovascularization among patients referred with age-related macular degeneration.

Aged↗
PubMed1993

Foveal cone ERGs in fellow eyes of patients with unilateral neovascular age-related macular degeneration.

PURPOSE: To determine whether fellow eyes with normal visual acuity of patients with unilateral neovascular age-related macular degeneration (AMD) have retinal malfunction. METHODS: Foveal cone electroretinograms (ERGs) were recorded from fellow eyes with visual acuities of 20/25 or better of 73 patients with unilateral neovascular AMD and from 28 normal volunteers of comparable age. Responses were elicited with a 4 degrees stimulus flickering at 42 Hz presented by a stimulator-ophthalmoscope. RESULTS: The study eyes of the patients were found to have foveal cone ERGs that, on average, were normal in amplitude but delayed in implicit (peak) time after adjustment of the data for age, sex, iris pigmentation, and refractive error by multiple linear regression. Based on all subjects, amplitude declined with increasing age and was smaller in eyes with darker irides; implicit time increased with increasing age. CONCLUSIONS: These findings suggest that fellow eyes with normal visual acuity of patients with unilateral neovascular AMD tend to have foveal cones that are normal in number but that function abnormally. In addition, foveal cone ERG amplitude should be adjusted for both age and iris pigmentation and implicit time should be adjusted for age when assessing retinal function of elderly patients.

Aged↗
PubMed1991

Hydroxychloroquine retinopathy.

We analyzed ocular findings from two patients (aged 49 and 60 years) with hydroxychloroquine (Plaquenil, Winthrop Pharmaceuticals, Division of Sterling Drug, Inc., New York, New York) retinopathy. Both patients were treated for systemic lupus erythematosus; one patient was treated with 400 to 800 mg of hydroxychloroquine per day (6.1 to 12.2 mg/kg of body weight/day) over a ten-year period. Cumulative doses were 1,788 and 2,920 g, respectively. Neither patient had ever been treated with chloroquine. One patient complained of glare and difficulty in adjusting to changes in illumination, whereas the other was asymptomatic. Both had bilateral visual acuities of 20/25, pericentral scotomata, and increased final dark-adapted rod thresholds in the two retinal areas that were tested. Fullfield electroretinograms were reduced and delayed, and focal cone electroretinography showed abnormal foveal responses as well. Ophthalmoscopy and fluorescein angiography showed a bull's-eye maculopathy in both eyes of one patient and perifoveal depigmentation in both eyes of the other patient. Retinal function remained stable at follow-up examinations 18 to 24 months after the cessation of hydroxychloroquine treatment. These two cases demonstrate that peripheral retinopathy, as well as maculopathy, can develop in patients who are treated with hydroxychloroquine for systemic lupus erythematosus, and that retinal function may remain stable after discontinuation of hydroxychloroquine treatment.

Electroretinography↗
PubMed1991

Relationship of oscillatory potential amplitude to A-wave slope over a range of flash luminances in normal subjects.

The effect of flash luminance on the relationship of oscillatory potential (OP) amplitude, as a measurement of inner retinal function, to a-wave slope, as a measurement of photoreceptor function, was evaluated in full-field electroretinograms recorded from normal subjects. The ratio of OP amplitude to a-wave slope was found to be independent of flash luminance over a 3000-fold luminance range. This finding raises the possibility that a reduction in the ratio of OP amplitude to a-wave slope in eyes with media opacities may be used as a sign of inner retinal malfunction. Selected cases are presented to illustrate application of this approach.

Adult↗
PubMed1990

Neovascular glaucoma following pars plana vitrectomy for complications of diabetic retinopathy.

The patient charts of 81 consecutive vitrectomies performed for complications of proliferative diabetic retinopathy were reviewed. Sixty-five preoperative, intraoperative, and postoperative variables were analyzed. In eyes with completed panretinal photocoagulation, only postoperative retinal detachment had a statistically significant correlation with postvitrectomy development of neovascular glaucoma. Eighty-three percent of eyes with detached retinas, as compared with 4% of eyes with attached retinas, developed neovascular glaucoma (P less than .00001). Aphakia alone did not have a statistically significant effect on the development of neovascular glaucoma; however in the presence of retinal detachment the incidence was very high (92%). Our study shows that a completely attached retina and aggressive panretinal photocoagulation are of paramount importance in decreasing the risk of neovascular glaucoma following vitrectomy for complications of proliferative diabetic retinopathy.

Adult↗